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Wednesday Feb 11, 2015

Under Attack: We Can All Join the Fight for GME Funding

For thousands of U.S. medical school seniors, the end is drawing near. In less than five months, they will be completing their fourth year of undergraduate medical training and gaining those two highly prized letters at the end of their name: M.D. But their work is far from complete.

Throughout the fall, they traveled the country interviewing for residency spots at programs large and small. Now, with the National Resident Matching Program -- better known as the Match -- only six weeks away, their anxiety is starting to grow.

Getting into medical school was difficult. According to the Association of American Medical Colleges(www.aamc.org), more than 40 percent of those who apply are turned away. Getting through medical school was difficult, too. Hours of classes, tests, clinical clerkships and overnight call. Next stop, residency. Getting in the door there is no easy task, either, and now it looks like the process could get even harder.

At a time when a shortage of primary care physicians is getting worse, hundreds of family medicine residency positions are in jeopardy.

The Patient Protection and Affordable Care Act created the Teaching Health Center Graduate Medical Education(bhpr.hrsa.gov) (THCGME) program to increase the number of primary care physicians. Unfortunately, the federal government's $230 million investment in that innovative program -- and other critical primary care programs -- is set to expire this year. In a survey last year, two-thirds of THCGME program directors said they likely would be unable to continue supporting current residency positions without continued federal funding.

 

Some aren't waiting to see whether or not Congress will act, and it's hard to blame them for being cautious. The Fresno Bee reported(www.fresnobee.com) Jan. 31 that the Sierra Vista Family Medicine Residency program in Fresno, Calif., already has decided not to take on a third class of residents in anticipation of a funding shortfall.

That program had received nearly 800 applications for four residency slots, but the program needs $2.4 million over three years to train each class of four residents.

Nationally, there are 60 teaching health center programs with a total of more than 500 family medicine residency slots. If Congress fails to reauthorize and adequately fund the THCGME program, how long will it be until we hear of more residencies pulling the plug on residency positions?

You've invested considerable time and money and likely amassed a daunting level of debt to pursue your goal -- your dream -- of becoming a physician. But if you're medical student, you might be wondering how this funding crisis could affect your spot in the Match. And if you're a resident at a teaching health center, you might be worried -- justifiably so -- about whether or not you get to keep yours.

So what is the AAFP doing about it?

  • Last fall, the Academy released a proposal that built on recommendations for GME made by the Institute of Medicine earlier in the year. The AAFP's plan would, among other things, significantly change the way GME is financed.
  • Two months later, AAFP leaders were on Capitol Hill to discuss several key issues -- including funding for teaching health centers -- with legislators and congressional staff.
  • GME likely will be one of the topics on the agenda when the AAFP Board of Directors spends another day lobbying on Capitol Hill later this month.
  • The AAFP and the Council of Academic Family Medicine recently responded to the House Energy and Commerce Committee's request for comments on GME reform with a letter that reinforced the concepts in the proposal released last fall, including support for community-based training programs and the need for accountability for the roughly $9 billion in federal GME funds that are funneled through academic health centers.
  • That letter is just one of many the Academy has sent to Congress regarding GME reform in recent months.

Health care faces a "primary care cliff" in 2015. In addition to GME, funding for the National Health Service Corps and community health centers also is set to expire this year. We students and residents can do our part by getting directly involved in the advocacy efforts of the Academy and our state chapters. For example, efforts by students and residents last year helped the Pennsylvania AFP secure state funds for nine new family medicine residency positions(www.nxtbook.com) and a development program for residents interested in practicing in underserved areas.

Students and residents also should be aware of scholarship opportunities to attend the Academy's Family Medicine Congressional Conference (FMCC). The May 12-13 event in Washington trains family physicians (and students) to advocate for patients and family medicine and concludes with a day of lobbying on Capitol Hill. The deadline for scholarship applications is March 6.

Whether you attend FMCC or not, your legislators need to know how funding cuts to primary care programs affect medical training and health care in their states.

Andrew Lutzkanin, M.D., is the resident member of the AAFP Board of Directors.

Posted at 03:47PM Feb 11, 2015 by Andrew Lutzkanin, M.D.

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